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Background: Many factors contribute to the risk for subsequent anterior cruciate ligament reconstruction (ACLR) within 2 years from the index procedure. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to evaluate the incidence of subsequent (revision or contralateral) ACLR at 2 years in a large cohort and (2) to explore the association between patient-specific factors and early subsequent ACLR risk by age group. We hypothesize that 2-year subsequent (revision or contralateral) ACLR rates will be low and that risk factors for subsequent (revision or contralateral) ACLR will vary depending on a patient’s age group. Study Design: Case-control study; Level of evidence, 3. Methods: The California Office of Statewide Health Planning and Development Ambulatory Surgery Database was retrospectively reviewed to assess the incidence of 2-year subsequent (revision or contralateral) ACLR and to identify patient-specific risk factors for early subsequent (revision or contralateral) ACLR by age group between 2005 and 2014. Results: Of 94,108 patients included, the rate of subsequent (revision or contralateral) ACLR was highest in patients younger than 21 years (2.4 per 100 person-years; 95% CI, 2.3-2.6) and lowest in those older than 40 years (1.3 per 100 person-years; 95% CI, 1.2-1.4). Younger age, white race (compared with Hispanic in all age groups and Asian in age <21 or >40 years), private insurance if age younger than 21 years, public insurance or worker's compensation claims if age older than 30 years were significantly associated with an increased risk of subsequent (revision or contralateral) ACLR at 2 years. Conclusion: Results of the present study provide insight into subsequent (revision or contralateral) ACL reconstruction, which can be used to assess and modify treatment for at-risk patients and highlight the need for data mining to generate clinically applicable research using national and international databases.

Background: Among collegiate sports, ice hockey and wrestling have been reported to have the highest rates of concussion injury. Recent literature has shown that among all sports, female soccer players had the highest rate of concussion injury at the high school level. Sport-specific analysis will increase our knowledge of epidemiologic characteristics of this serious injury in young soccer players, where “heading” is commonly involved during participation. Hypothesis: Heading during soccer will be associated with increased frequency of concussion injury in collegiate female players compared with other mechanisms of injury, and concussion injury mechanism and rates will differ by setting of injury (practice or match) and player position. Study Design: Descriptive epidemiologic study. Methods: This was a retrospective review and epidemiologic analysis of all concussions documented from a single National Collegiate Athletic Association (NCAA) Division I female collegiate soccer team between 2004 and 2017. A total of 381 participants were reviewed, and concussion injury mechanism, setting (practice or match), player position, and number of games and practices missed due to injury were analyzed. Results: Overall, 25 concussions in 22 players from the 2004 to 2017 seasons were identified, for an annual rate of 1.79 concussions per year. Collisions (36%) followed by headers (20%) were the most common mechanisms. Forwards sustained the most concussions (32%). Injuries were more common in games (56%) than practice (40%). Of note, the most common cause of concussion during practice was headers (40%). Of the concussions documented, 20 (91%) were the player’s first concussion. On average, each concussion resulted in a player missing 3.96 games and 12.46 practices. Conclusion: Our results demonstrate that concussion rates in female NCAA soccer players vary by position and occur with different frequencies and mechanisms in practice and games. Interventions for concussion avoidance should aim to limit exposure to high-risk activity, including player-to-player contact in games and headers in practice. Although gameplay and collisions can be unpredictable and difficult to control, practice settings can be modified in an attempt to decrease risk.

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External fixator use for the treatment of distal radius fractures steadily declined during the study period. Males and those with lower incomes treated in rural, nonteaching, and privately owned hospitals are more likely to receive external fixation.